Advance Directives; Why Everyone Needs Them and Needs Them Now
Advance directives are documents that communicate your wishes about your medical care in the event you are not able to speak for yourself. Many people think that advance directives are meant for people who are elderly or ill, and therefore do not have them prepared for themselves. In reality though, advance directives are essential for everyone to have, regardless of age or health status. Read ahead to understand why you need these documents and why you should take action today to create them.
We hear countless stories of people suffering from unexpected, catastrophic accidents or the sudden onset of illnesses (especially in the time of this COVID-19 pandemic) that result in incapacitation. If that were you, how would you make sure your wishes about your medical care are known when you are not able to communicate? Advance directives do just that, and the great news is that they are easy to create and completely free.
An advance directive not only serves you, but it also helps your loved ones in their medical decision making process at a time that can be deeply upsetting and chaotic. Instead of having to guess about what your wishes might be, these documents give your family/ friends peace of mind and reduce confusion, minimize stress, and reduce disagreements about your medical care. I have seen families with significant conflict (and sometimes complete estrangement) that results from not being on the same page about their loved one’s medical care, and advance directives can help prevent this
So what exactly do advance directives consist of and how do you go about creating them? Advance directives refer to two primary documents, a living will and a medical power of attorney; both are written documents. You can ask a lawyer to help you create your advance directives, but this is not necessary and you can easily download the paperwork online. Know that each state has different forms and requirements (e.g., some states may want your forms to be signed by a witness or notarized). I will provide links below to some resources that will help you determine what exactly you need.
Living Will
A living will is a document that outlines your wishes for medical care if you are incapacitated. This is only used to help guide decisions on your behalf when you cannot decide for yourself and you can change it at any time. A living will will ask you to think about what medical interventions you would be willing (or not willing) to have, quality of life issues, and how aggressive you want your medical team to be with your care. For example, if you suffered permanent brain damage with no hope of recovery, would you want to continue living through medical means (e.g., a ventilator)? These are often difficult situations to consider– and unlikely to happen– but invaluable in helping guide your care in the event the unexpected occurred.
A living will asks you to consider interventions like:
Resuscitation
Ventilation
Tube feeding (artificial nutrition)
Artificial hydration
Comfort care
Donating your body for scientific reasons
Organ/ tissue donation
Medical Power of Attorney
A medical power of attorney is a document that allows you to name someone to make medical decisions on your behalf when you are incapacitated. Some people elect to name their spouse, adult children, siblings, parents, or friends to serve in this role. This person can be called a number of other things, including a health care agent, health care proxy, health care surrogate, or health care representative. The person(s) you choose should be someone you trust to carry out your wishes even if they are at odds with what that person might want for you. It also is a good idea to choose one or more alternates in the event that the primary person is unable or unwilling to serve at the time they might be needed.
Additionally, while a living will asks you to think about some medical situations you might be in, not every situation can be pre-planned. Your health care proxy should know your values in such a way that they can reasonably guess what you would have wanted to do in a situation that was not anticipated. After you name a person(s) in your medical power of attorney documentation, be sure to have a conversation with them letting them know that you have chosen them for this role and making sure that they are comfortable carrying out your medical wishes. It is helpful to give this person a copy of your advance directives so they have access to them if need be.
Creating advance directives
State-specific advance directive forms can be found at the:
US Living Will Registry: https://www.usacpr.net/individuals-families/forms-list/
American Bar Association (ABA): https://www.americanbar.org/content/dam/aba/administrative/law_aging/2018-lnks-to-st-spcifc-advnc-drctv-frms.pdf
When you have completed your documents and reviewed them with your doctor to make sure they have been filled out correctly, keep a copy in a safe (but accessible) place and give additional copies to your health care agent, your doctor, and your medical record. For a small fee, you also can upload your documents to a secure, national database (The US Advance Care Plan Registry: https://www.uslivingwillregistry.com/store/pc/viewPrd.asp?idproduct=1) so that your advance directives can be accessed if needed if you are traveling or in a hospital away from home.
While you can change your advance directives at any time, you may want to consider revisiting them every 10 years to review your choices and assess if you would like to make any changes. Other times to consider reviewing these documents would be if you have a change in your marital status (e.g., may want to select a new health care proxy) or you receive a diagnosis that changes the decisions you might make about your care. If you do make changes, be sure to update your medical file with the new documents and distribute copies to your health care agent.
Congratulations on making it to the end of this blog, on a topic that can be hard to think about and not the most fun to read about! At this point, I hope you will grasp the value of establishing advance directives and make a commitment to fill yours out today. Drop me a line at michellebronzocounseling@gmail.com to let me know when you have taken this important step for some extra kudos!
Additional topics to discuss with your lawyer or financial planner in regards to planning for the unexpected (estate planning):
Power of attorney– allows another person to handle your financial or legal affairs.
Designation for disposition of remains– burial, cremation, whole body donation, etc.
Life insurance
Last will and testament
Electing guardians for your children
Transfer of property ownership
Estate taxes
Pre-funding a funeral or memorial service
Electronic records– recording your userIDs and passwords to access online account information
